In rural or impoverished pockets of the world, where disease is prevalent, doctors are scarce, and health care infrastructure is inadequate, telemedicine is an innovative solution that connects the developing world to the resources of the developed world. Telemedicine, defined by the WHO as “the use of information and communications technology (ICT) to deliver health care particularly in settings where access to medical services is insufficient,” holds promise in expanding health care access worldwide. Certain aspects of telemedicine, however, are often difficult to implement in underdeveloped settings and should be addressed to capitalize on the potential these new tools offer.

Courtesy of Glenn Edwards

Telemedicine can employ a multitude of modern technologies, transmitting information via text, audio, video, or still images to a range of specialists. It is relevant to a variety of disciplines including dermatology, radiology, and cardiology. With a simple Internet connection, patients can videoconference with a health care professional half-way around the world or email MRI scans for medical analysis. More remarkably, without any face-to-face interaction, doctors can distantly monitor the blood pressure or glucose levels of a clinic’s patients through a computer screen.

For regions without adequate healthcare infrastructure, the possibilities of telemedicine are tremendous, as it enables effective medical care despite understaffed clinics and undertrained practitioners. Basic telemedicine initiatives can be established with low start-up costs.

As Kathleen Fiamma, a Senior Remote Consultation Coordinator at the Center for Connected Health, said in an interview with the HCGHR, “As long as you have a computer, Internet access, and a camera, you can do telemedicine.” The Center for Connected Health is a Boston non-profit that runs Operation Village Health, a project that provides health services in two Cambodian villages using a few cameras and a handful of donated x-ray, ultrasound, and EKG machines. Doctors at Massachusetts General Hospital and Brigham and Women’s Hospital provide remote consultations for these patients at no charge.

In general, telemedicine potentially eliminates a number of other costs, including travel expenses for specialists and patient transfers. In a resource-constrained setting, this can have a substantial impact on health care access.

Local nurses can perform telemedicine by using a simple digital camera to document a patient’s ailment and sending it to a specialist doctor for consultation. (Courtesy of Glenn Edwards)

Moreover, by utilizing these technologies, local doctors are able to learn from more experienced physicians across the globe. For Operation Village Health, nurses provide a diagnosis and outline treatment strategies before e-mailing patient data to Boston doctors, who then revise these proposals as they see fit. With practice, local nurses are better able to recognize particular diseases and devise treatment options.

Kathleen Fiamma observed, “A lot of the problems that we had seen an abundance of in the beginning we do not see any longer, and I think that is just because [the local nurses] know how to manage them so well that it is second nature to them.” At first, language barriers and unfamiliarity with technology often inhibit communication between professionals, but these issues are usually solved with time, as both parties grow accustomed to working with one another.

Although telemedicine may reduce physical barriers to care, it also can generate a new series of concerns that need to be addressed in order to produce successful outcomes. The Opportune Breast Cancer Screening and Diagnosis Program (OBCSDP), a pilot program initiated in rural Mexico to send mammograms to radiologists in cities via the Internet, recognized equipment breakdowns and impossibly slow Internet connections as major impediments. Adrian Pacheco, director of the Centro Nacional de Excelencia Tecnológia en Salud, explained to the HCGHR, “The biggest challenge is [Internet] connectivity. The diagnostic centers are ready and available to do more than 150 screenings every day and they do not reach even 50.”

While OBCSDP is working to acquire more reliable technologies, doctors instead place the image scans on CDs and use ground transportation to deliver them; this serves as a good interim solution but results can take up to three weeks, substantially delaying the diagnostic process.

The lack of an international framework to enable health care professionals to deliver medical services outside of their licensed jurisdiction presents another barrier. Furthermore, transmitting patient files via the Internet threatens patient privacy. To address this concern, non-profits such as the Center for Connected Health are working toward solutions like making Skype, a videoconferencing tool, compliant with medical codes so that doctors can communicate over the Internet without the liability of breaching doctor-patient confidentiality.

Finally, despite their successes, telemedicine programs are still working to achieve the results needed to propel this new mode of health care forward. A survey by the Pan-Asian Networking Project, which studies the effects of telemedicine in India, emphasizes the importance of documenting the cost-benefits of telemedicine programs in order to rationalize initial ICT expenses to potential investors.

In a world where income level, ethnic origin, and geographical location serve as primary determinants of people’s access to health care, telemedicine constitutes a possible approach to overcoming many of the existing barriers to care.

While there are still many concerns that lie in the way, Dr. Joseph Kvedar, Director of the Center for Connected Health, asserted to the HCGHR that telemedicine is exceptionally promising due to “the great value that can be brought… by the possibility of time and place independence in health care.”